The full name of what’s commonly known as diabetes is ‘diabetes mellitus’. When the condition was first identified, physicians realised the urine of this group of patients contains sugar—which we now know to be glucose. Scientists have found out that this unique phenomenon is due to the arguably most well-known symptom of diabetes: the presence of abnormally high blood glucose levels, where the human body loses its ability to effectively down-regulate the glucose in the bloodstream.
Diabetes significantly increases one’s risk for cardiovascular disease, and if not well controlled can reduce neuropathy in limb extremities. One of the problems it may lead to is nerve damage in feet. Other unpleasant issues such as poor and delayed wound healing, urinary tract infections, fatigue, kidney problems as well as eye issues, can all dramatically reduce life quality. This will lead to the next point of today’s blog, which explains the different types of diabetes mellitus.
Types of diabetes, treatment, and risk factors
One of the most important hormones in the body is insulin. Insulin is produced in the pancreas and is used to regulate the level of glucose in your blood. When it comes to glucose, it is what cells use as energy, but unusually prolonged high blood glucose levels can lead to a range of complications.
When we eat food, especially carbohydrates, they will be broken down into glucose and absorbed by your intestine into the bloodstream. Naturally, the glucose level in the blood will rise. However, at this point, the glucose cannot be used by the cells yet. It must find a way to enter the cells from the bloodstream so that the cells can utilise them to release energy and support a range of core cell activities; such as releasing energy, producing heat, and creating muscle movement.
So how is this achieved? This is where insulin comes in. Insulin is released whenever the body detects a rise in blood glucose level, and essentially allows the cells to transport the glucose from the bloodstream into the cells to be used. Thereafter, blood glucose levels can then come down again as a result.
Type 2 diabetes
When we talk about diabetes, many refer to either type 2 or type 1 diabetes. Type 2 diabetes being the most common form of diabetes, and accounts for almost 90% of all diabetic diagnoses. In these scenarios, the tissue and cells become insensitive to insulin. That is, even when the body releases a more insulin in response to the increased presence of glucose in the blood, the cells do not perform the action of allowing glucose in. This means high levels of glucose can remain in the bloodstream.
Traditionally, most type 2 diabetes is diagnosed in adults over the age of 40. But unfortunately, just like many other chronic diseases, there is a trend of new diagnoses in younger people and even children in recent years. What’s worth mentioning is that type 2 diabetes is closely related to obesity, hence the increase in the obesity rate among young individuals may be one of the factors contributing to this prevalence. Following this thought, weight management becomes crucial in preventing type 2 diabetes. Even for those who have already been diagnosed, losing just 5% of body weight may help induce what’s known as the ‘remission period’; where the condition progression is paused for a certain period.
If we go on to the treatment and management of type 2 diabetes, it can be largely divided into 2 equally important parts. The first route is pharmaceutical management. Medications such as metformin, sulphonylureas, glinides and insulin all have different functions. Some of them increase insulin sensitivity, some stimulate insulin production, while others suppress spikes in blood glucose after eating a meal.
Lifestyles managements include physical activity and dietary modifications. Physical activity can greatly reduce the risks for comorbidities such as cardiovascular disease, while also helping to lower blood glucose levels. When combined with a dietary approach, it also helps support with weight loss. The overall goal of dietary management is to avoid large fluctuations in blood glucose level (this goes both ways), hence achieving blood glucose control (glycaemic control). This involves promoting a healthy well-balanced diet, reducing alcohol intake and refined carbohydrate, to minimise the risk for other common complications that can potentially come with diabetes. In particular, refined carbohydrates are known to cause large increases in blood glucose levels after eating. Therefore, it is recommended to choose complex carbohydrates such as brown bread or rice, oats and vegetables instead of sugar sweetened beverages, white bread and sweetened foods. If you are diagnosed early, you may not need insulin or most of the oral medications. Dietary management in combination with exercise may successfully slow down the progression of type 2 diabetes, hence can make a great impact in the long-term disease prospect as well as life quality.
Type 1 diabetes
With type 1 diabetes, the pancreas may produce insulin in very small, insufficient quantities, or it may not produce insulin at all, lacking essential processes. This dysfunction of the pancreas is a result of an autoimmune attack, where the insulin-producing cells are gradually destroyed by the body’s immune system. The exact mechanism of this process is still yet to be further investigated.
The management of type 1 diabetes almost always involves what’s known as insulin replacement therapy. This makes sense when you think back to the beginning of the article, where it’s been explained that people with type 1 diabetes do not have insulin insensitivity, they just cannot produce enough quantity themselves. Hence, those with type 1 diabetes need to regularly inject themselves with artificial insulin, or use an insulin pump. One of the most common yet dangerous side effects of using insulin is that when the volume of insulin administered does not match the increase in blood glucose level, in other words, your cells are dragging too much glucose from the bloodstream into cells when there isn’t much glucose left in the blood, a condition called hypoglycaemia can occur. When the blood glucose level reaches a dangerously low level, one could develop dizziness and heart palpitation quite quickly, and in the worst-case scenario can even faint or die. Therefore managing diabetes isn’t about getting the blood glucose to as low as possible, it’s rather about controlling it to be in a normal healthy range to support normal activities and daily life.
Just as is the case in type 2 diabetes, carbohydrate intake also plays an integral role in the management of type 1 diabetes. Many people with this condition practice what’s known as carbohydrate counting. They calculate the carbohydrate content of their meals to the nearest 10g and use this as a predictor of the post-meal increase in blood glucose level. By doing this, they can adjust their insulin dosage accordingly, to achieve better glycaemic control.
Type 3c diabetes
The much rarer case of diabetes is type 3c. This is when insulin production is impaired due to a disease in the pancreas. For example, pancreatitis, cystic fibrosis, and pancreatic cancer are some of the major reasons for type 3c diabetes. The management of this type of diabetes is more complex than the other two forms of the disease, as it requires a combination approach: some treatments from what we use for type 2 diabetes, and some from the type 1 diabetes treatment toolbox. On top of this, you will also need to manage whatever illness that is causing the pancreatic dysfunction in the first place. If you do have a pancreatic condition such as the ones listed above, it’s always worth asking your doctor whether type 3c diabetes is something you should be concerned about. Due to the nature the complexity of this condition, we suggest that you should talk to your healthcare team or reach out to a registered dietitian specialising in diabetes for individualised advice on managing your own condition.
By Rutian Ding, Dietetic student, revised by Reema Patel, Registered Dietitian at Dietitian Fit & Co
Reference list
Diabetes UK (2015). Diabetes treatments. [online] Diabetes UK. Available at: https://www.diabetes.org.uk/diabetes-the-basics/diabetes-treatments.
Gandy, J. and British Dietetic Association (2019). Manual of dietetic practice. 6th ed. Hoboken, Nj: John Wiley & Sons, Inc, pp.715–725.
NHS (2022). What is type 1 diabetes? [online] nhs.uk. Available at: https://www.nhs.uk/conditions/type-1-diabetes/about-type-1-diabetes/what-is-type-1-diabetes/.
The British Dietetic Association (n.d.). What is Type 3c diabetes? [online] Diabetes UK. Available at: https://www.diabetes.org.uk/diabetes-the-basics/type-3c-diabetes.
